UPDATE Weekly

On May 26, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum on beneficiary disenrollment from Medicare Advantage (MA) Plans and dual demos. Specifically, CMS alleges that long-term care (LTC) facilities, including nursing centers and skilled nursing facilities are inappropriately encouraging Medicare beneficiaries to dis-enroll from MA plans and dual demonstrations.

In the transmittal, CMS indicates that the Agency has received reports that LTC facilities are disenrolling beneficiaries from Medicare Advantage prescription drug plans (MA-PDs) and enrolling them into stand-alone drug plans (PDPs), and that this practice has occurred without the beneficiary or their representative’s knowledge and/or complete understanding. Such practices are noncompliant with current CMS regulatory requirements.

Also in the memo, CMS states that any change in a beneficiary’s health care coverage must be initiated by the beneficiary or his/her representative. If a beneficiary or their legal representative requests assistance from the LTC facility in changing the beneficiary’s health coverage, the facility must take certain steps to ensure changes comply with regulations regarding enrollment/disenrollment and resident rights.

For more information on this issues, please refer to the following items:

CMS Disenrollment Memo, click here to read
AHCA Memorandum on Disenrollment Issues, click here to read

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The recently amended Personal Care Services policy has been posted and can be viewed by clicking here.

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NC Health Care Facilities Association presents ICD-10-CM Essentials for Long Term Care July 14th, 2015 in Raleigh, NC! As you know, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code set will soon replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set used to report medical diagnoses and inpatient procedures through the Health Insurance Portability and Accountability Act (HIPAA) standard transactions. Any provider covered by the Health Insurance Portability Accountability Act (HIPAA), including most long-term and post-acute care organizations must implement ICD-10-CM by October 1, 2015. After that date, providers will not be able to use ICD-9-CM codes.

Being taught by Pathway Health Services, this one-day seminar will have the following objectives:

• Learn structure, organization, and unique features of ICD-10.
• Understand basic coding guidelines.
• Demonstrate ability to look up and code basic diagnoses.
• Understand how coding relates to billing.
• Relate coding guidelines to all types of care.
• Know basic disease classification and how to use resource books.
• Be able to determine primary diagnosis.

The cost to attend this seminar is $185 for members and $370 for non-members. This fee includes handouts, morning and afternoon breaks. YOU CAN REGISTER AND PAY ON-LINE! TO REGISTER, GO TO http://NursingHomesNC.com AND CLICK ON ICD-10-CM Essentials for Long Term Care. You may also download a Brochure here! Members may be invoiced. Non-members must submit payment on-line or mail with registration. Registration is open to anyone who would like to attend! REGISTER TODAY!

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Make plans today to join your colleagues for the fourth annual NCHCFA Summer Symposium. The three-day event will be August 26-28, 2015 at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC.

Do not miss Regulatory Review & The Centers for Medicare and Medicaid Services (CMS) Civil Money Penalty (CMP) Analytic Tool: What’s It All About? on Wednesday, August 26th. In December of 2014, the Centers for Medicare and Medicaid Services issued to all State Survey Agency Directors a Survey and Certification Letter entitled “Civil Money Penalty Analytic Tool,” designed to bring about national consistency in the application and imposition of civil money penalties arising from surveys. Reports from the various CMS Regions indicate that the CMP analytic tool has had other consequences as well, including the rapid increase in the number and size of CMPs issued in CMS regions that typically imposed very few CMPs. The CMS analytic tool makes clear that all CMS regions must use the CMP Analytic Tool when imposing CMPs. This session will examine the CMS CMP Analytic Tool; the factors CMS is requiring each regional office to use in determining when to use a civil money penalty; and the actual computation methodology for civil money penalties. The CMP Analytic Tool does permit some discretion on the part of Regional Offices in determining the final civil money penalty amount. However, many of the factors the Regional Offices must now use are fixed such that providers can, within a reasonable range, determine the amount of a civil money penalty that will be imposed once they know the scope and severity of a cited deficiency or deficiencies and several other compliance-related factors. In this session, Ken Burgess will explain CMS’s CMP Analytic Tool; help providers understand the mechanism for predicting future CMPs and run examples through the CMP analytic tool.

In addition, NCHCFA Executive Vice President Polly Welsh will give an update on the latest regulatory data affecting skilled nursing facilities.

To view the 2015 Schedule at a Glance click here!

Call the Embassy Suites Resort at (800) 876-0010 to reserve your overnight room. Use group code “HCF” to identify yourself as a NC Health Care Facilities Association Convention attendee! To make your reservation on-line, visit http://tinyurl.com/2015symposiumroomblock. Please note that when our room block is full, rooms will be on a first come, first served basis at prevailing published rates.

Please call the Association office at (919) 782-3827 with any questions. Brochures will be available soon!

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Back by popular demand, NC Health Care Facilities Association will present a repeat seminar on August 11th, 2015 in Greensboro, NC! If you missed this seminar in May, you will not want to miss it again! This program will provide strategies for managing the people, records, and processes for responding to an auditor’s request for records and appealing denials. The role each person plays during this process includes coordination, preparation, documentation, and tracking. Preventing denials in the first place is part of a comprehensive compliance program as an internal QA function.

Topics include, but not limited to the following:

• Audits impacting nursing homes
• Who may audit you
• How to respond to audit requests
• Appealing audits
• The parts your employees play
• How to reduce/prevent audits

Here are only a few comments some of our attendees had to say:

“One of the best presentations I have been to in a while!”

“Speaker was very knowledgeable and enthusiastic with significant experience. Would like further trainings to be provided by this speaker!”

“Excellent presentation- so informative and helpful!”

“The speaker was terrific! Her knowledge is so vast! This was one of the best seminars I have attended!”

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They say things in Texas are bigger and better. The AHCA/NCAL 66th Annual Convention & Expo is shaping up to be just that, all from historic and beautiful San Antonio. Experience the food, the landmarks, and the fun of this Texas-sized destination, while you network, learn, and enjoy yourself at this must-attend event. This is not just a networking and educational event: this helps AHCA/NCAL further their mission to deliver solutions for quality care. The 66th Annual AHCA/NCAL Convention & Expo is a chance to share your knowledge and learn from your peers, your contemporaries, and experts in long term and post-acute care. The fact that it takes place in San Antonio, one of the southwest’s most colorful and entertaining cities, just makes it even better!

Everybody likes to save! The early bird registration for the Convention & Expo ends July 17th. What are you waiting for? Register now and get the lowest rates available. Additional savings are available when multiple people register from the same facility. There is something for everyone at the 66th Annual AHCA/NCAL Convention & Expo.

Clear your calendars and make plans to attend!

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The “Updated LEIE” (List of Excluded Individuals and Entities) database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in May 2015. This new “Updated LEIE” is a complete database file containing all exclusions currently in effect. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

All updated files are posted at http://oig.hhs.gov/exclusions/exclusions_list.asp.

Instructional videos explaining how to use the on-line database and the downloadable files are available as follows:

• On-line Database Video: http://oig.hhs.gov/exclusions/online.asp.
• Downloadable Database Video: http://oig.hhs.gov/exclusions/download.asp.

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This book will show you the true financial consequences of unchecked resident readmission and provide you with the tools to do something about it! It delivers several practical strategies your facility can employ, such as enhanced resident assessment and documentation policies, provider partnerships that improve transitions of care, staff education tools, and methods to achieve resident and staff involvement. You will learn how to ensure smooth care transitions through resident education and effective communication with staff and other care providers, reduce costs associated with re-hospitalizations and maintain or improve the resident’s quality of life.

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #8238
AHCA MEMBERS $129.00

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Karen Lennon at karenl@nchcfa.org. The price is $35.00 (tax and shipping included).

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It is not too late for your residents to sign up for the National Senior League Wii Bowling National Championships. Play begins the week of August 17th.

http://www.nslgames.com

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The oldest animal ever known, a hard clam, lived from 1499 until the day researchers cracked its shell open trying to determine its age, killing it in the process.

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